Catalyst for Payment Reform

Mythbuster: Medical interventions are the only effective treatment for Diabetic populations

Mythbuster: Medical interventions are the only effective treatment for Diabetic populations

The prevalence of Type II Diabetes continues to soar in the United States with an estimated 1.5 million new cases diagnosed every year.  Unsurprisingly, strategies to mitigate costs and improve outcomes associated with this chronic disease are top of mind for health care purchasers and policy makers. Lowering or maintaining a normal blood glucose level is the key to cost-savings and better outcomes for diabetic and pre-diabetic patients. One route to achieving this goal is pursuing payment reform initiatives in chronic care management that hold providers accountable to administer a Hemoglobin A1c test at least once a year for diabetes patients. This important metric is one of the macro-indicators included in CPR’s Scorecard on Payment Reform 2.0.

But other solutions also hold promise! According to the Center for Health Law and Policy’s (CHLP) 2015 Report “Food is Prevention,” nutrition interventions have been shown to significantly reduce blood sugar levels in several pilot programs and randomized control trials.

The biggest nutrition intervention program in the United States, the Supplemental Nutrition Assistance Program (SNAP), helps upwards of 40 million Americans purchase healthy food. A recent study published in JAMA Internal Medicine found that low-income Americans enrolled in SNAP spent approximately $1,400 less in total health care expenditures per year compared to their peers from similar backgrounds who weren’t SNAP beneficiaries. These consumer savings are significant, especially in the context where one in three Americans with chronic illness reported being unable to afford food, medication, or both in 2014.

For interventions on a smaller scale, the evidence is more of a mixed bag. The CHLP report mentioned above reviews the results of nutrition interventions in the care management of chronic diseases, including cardiovascular disease, cancer, and HIV/AIDS. Together with diabetes, these chronic diseases are significant cost drivers in health care spending, with a lot of room for cost-saving innovations. But not all the interventions found statistically significant positive results when evaluated. One program that did register as a success was the grant from the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program that allowed Texas to pioneer the use of food subsidies to incentives their Medicaid population to purchase healthy food. Texas’ experiment found significantly more weight loss in the treatment group compared to control.

There has been some movement in nutrition-centered programs in the commercial sector as well. A partnership between Humana and Walmart offers Humana clients discounts for healthy food purchased at Walmart Stores since 2012. In addition, Harvard Pilgrim Health Care has partnered with the nutrition intervention vendor NutriSavings since 2014, and, in the first year, more than half of members who chose to participate in the program received cash rewards for meeting a threshold of healthy purchases.

Unfortunately, nutrition interventions are riddled with the same challenges as other new models for creating higher-value health care: lack of evidence and a standard framework for their evaluations. Here at CPR, we will keep our ears out for more evidence and further movement in the promising field of nutrition for improving quality of care, and help employers and other purchasers navigate the options along the way. After all, the founder of medicine himself, Hippocrates, did say, “Let food be thy medicine and medicine be thy food.”

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